Chapter 31 (Extreme Cards!) Flashcards
Bronchitis
What it is: Inflammation of Bronchiole tree due to inflamed mucous membranes and increased mucous production resulting in congested airways. If it occurs 3 months out of the year for 2 years it’s chronic.
Bronchiectasis
What it is: Dilation of Bronchial airways causing flabby scarred areas resulting in pooling lung secretions.
What causes it: Usually occurs secondary to disorders such as cystic fibrosis, asthma, TB, bronchitis, or toxin exposure. Can also be caused by obstruction by a tumor, excess secretion, or foreign body. Inflammation or infection may weaken bronchial walls and reduce ciliary function. Vitamin D deficiency may also be a factor.
What to look for: copious purulent foul-smelling bloody sputum, extreme airway inflammation, dyspnea with minimal exertion, wheezes, and crackles, clubbing of fingernails when chronic, fever during active infection. Cor pulmonale right sided HF
Dx tests: Chest x-ray for early detection, CT to view the dilated airways causing pooling, sputum culture for the organism, and best antibiotic treatment.
Meds: Azithromycin (Zithromax) reduce exacerbation of symptoms, Flu/Pneumonia vaccines to prevent infection, Bronchodilators to relieve obstruction and relax smooth muscles, Mucolytic agents to loosen secretion making them easier to cough and collect. Bronchial sugar used to draw out secretions, corticosteroid and leukotrienes inhibitors to reduce inflammation, Chest Physiotherapy to mobilize secretions through a vest. NIPPV to maintain oxygenation, oxygen for hypoxia prn, oral fluids encouraged, surgery if there’s a localized diseased area.
Tip: When PT coughs a lot of sputum put tissue in the basin to better see sputum and sputum color.
Pneumonia
What it is: Inflammation and/or infection caused by a variety of different bacteria that multiply within the lungs.
Who’s at risk: very young adults, adults over 65, smokers, people with chronic disease, and immunocompromised people such as those with AIDS. Also alcoholics, and those on meds that reduce immunfunction.
Types HAP hospital aquired pnuemonia VAP ventilator associated pnuemonis HCAP healthcare associated pnuemonia CAP community aquired pnuemonia Bacterial pnuemonia Viral pnuemonia Fungal pnuemonia Aspiration pnuemonia Chemical pnuemonia
Prevention: Flu & Pnuemonia shot! regular coughing, deep breathing and position changes for PT’s on bedrest after surgery, frequent mouth care with clorahexidine, ET with continuos suctioning, head of bed position 30-45 degrees to prevent aspiration, meds that reduce stress ulcers and gastric secretions may increase bacterial growth.
S/S: Fever, shaking, chills, chest pain, dyspnea, fatigue, and productive cough. Rust colored or blood tinged sputum, crackles and wheezes due to lung exudate
fatigue, sore throat, dry cough, nausea, vomiting, new onset confusion due to decreased oxygenation
complications of pnuemonia: Plurisy and Plural effusion usually cause the pnuemonia, and atalectasis occurs due to the trapped secretion in the alveoli, incentive spirometer helps to clear this, the bacteria from the pnuemonia may have spread throughout the body causing other issues such as septicemia, meningitis, septic arthritis, pericarditis, and endocarditis. All this is treated with antibiotics
Dx tests: Chest x-ray determines pulmonary infiltrate leakage of fluid into alveoli, sputum and blood cultures used to identify the cause of pnuemonia and best antibiotic treatment. Nebulized Mist Treatment, Nasotracheal suctioning, or bronchoscopy can be done to obtain specimen.
Tip: get specimen before giving antibiotics, morning is always best, but if PT has eaten breakfast ensure they rinse with water.
Interventions: Rest, and fluid, occassional antivirals, and braod spectrum antibiotics given as soon as specimen is given to lab, and narrow spectrum maybe ordered after the specimen is determined.
Pneumonia Summary
S/S: Fevers, chills, crackles, wheezes, dyspnea, chest pain, productive cough.
Dx test: Chest x-ray, Sputum culture
Interventions: Antibiotics, supplemental oxygen, bronchodilators, expectorants, rest, and fluids.
Complications: Pluerisy, Plueral effusion, atalectasis
TB
What it is: an infectious disease caused by mycobacterium tuberculosis it primarily harms the lungs but is able to travel through lymph nodes to kidneys, liver, brain, and bone. It’s an acid bacillus that when washed with acid gets stained fast usually enters the body when inhaled. TB without a disease is caused latent and this is when the immune system learns to fight it, then a lesion called a tubercle seals the TB away and it only becomes active in 5-10% of people who are usually immunocompromised.
